HARVARD VANGUARD MEDICAL ASSOCIATES Major Systems

HIT & Electronic Medical Records
Information Technology at Cambridge Health Alliance
Integrated Care Delivery Innovations
NAPH Webinar
May 1, 2013
Judy Klickstein
SVP Information Technology & Strategic Planning
Chief Information and Strategy Officer
Agenda
 Cambridge Health Alliance (CHA) Overview
 Information Technology at CHA
 Intersection of Strategy, Operations and IT Solutions
 Discussion/Questions
2
Cambridge Health Alliance History
 Created in 1996 with the merger of two Boston-area
hospitals - Cambridge City Hospital and Somerville Hospital;
Acquired Whidden Hospital in Everett, MA in 2001
 Operates a network of 20 plus primary care and specialty
locations
 Places special emphasis on preventive care and in serving
the area's most vulnerable and diverse population (Safety
Net, Disproportionate Care /DSH)
 Regional, academic healthcare system: only remaining
public health system in Massachusetts
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Overview of Cambridge Health Alliance:
Integrated Healthcare System
Hospital: 3 campuses with 24-hour Emergency Services:
Community-based Primary Care and Mental Health Services:
Public Health
CHA Foundation
CHAPO-CHA Physicians Organization (Medical Services
Organization only)
 Teaching affiliations with:
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Harvard Medical School, including innovative longitudinal 3rd year
integrated clerkship
Tufts Univ. School of Medicine
Harvard School of Public Health Teaching Affiliate
 Residency Programs
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FY 12 Snapshot
Total System Operating Budget:
Delivery System Operating Budget (Hosp & MD):
Number of Beds (M/S, Critical Care, OB, Psych):
Total Discharges:
Average Daily Census:
Number of Outpatient Locations:
Total Outpatient Visits:
Total Emergency Dept. Visits:
Number of Employed FTEs:
$810 M
$543 M
264
13,345
177
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664,875
98,937
- Hospital
2,921
- CHAPO
315
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Regional Safety Net Provider
Critical Government Funding Stream
 Largest proportional provider of care to low income
individuals in the State
 Care for uninsured patients from over 230 MA communities:
3 times greater Medicaid and low income public payer mix
and 4.4 times greater uninsured care than statewide acute
hospital average
 Many patients travel to overcome access-to-care barriers
(uninsured or under-insured, culturally and linguistically
appropriate care)
 40% of patients speak language other than English
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Safety Net Provider – continued
 Leading state-wide acute hospital provider of inpatient
psychiatry
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11% of all statewide inpatient mental health stays
27% of all statewide mental health stays for the uninsured
greater than 30% of our patients and 53% of our mental health
patients come from outside our 7-town primary service area
 Rely on ADEQUATE SUPPORT from the State and Federal
government to provide this care (Supplemental Revenues;
“DSH” funds).
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CHA’s FY 13 Strategic Focus Areas
 Develop and implement multi year plan for financial
sustainability
 Improve patient experience of care
 Complete strategic partnership/clinical affiliation
 Continue investment in transformation:
 Clinical practice transformation to Patient Centered Medical Home
model of care
 Ability to accept alternative means of financing through
development and investment in Accountable Care Organization
infrastructure
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IT Guiding Principles
1. Support Alliance strategic directions and key initiatives
2. Use systems and technology to enable change, reduce
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waste, enhance productivity, improve efficiency and
facilitate patient safety and centeredness
Leverage existing investment in technology and
applications
Introduce new technology that offers a strategic and cost
advantage; that is flexible, stable, and increases access to
data
Partner with administrative and clinical leadership
Continuously improve overall IT performance, leadership,
and service
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IT Guiding Principles - continued
7. Continuously improve IT staff satisfaction: provide career
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progression opportunities, satisfying and challenging work
and a supportive work environment
Utilize web based/rapid development for small to medium
applications to complement major vendor reliance
Implement intuitive, user friendly design/tools
Provide accessible data that is consonant with the Baldrige
principle of being a data driven organization
Leverage system integration tools which support interfacing
key systems to enhance clinical data flow, improve
demographic data and streamline billing
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Oversight- Information Technology
Steering Committee (ITSC) Objectives
 Ensure that Information Technology efforts are in sync with Cambridge
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Health Alliance priorities, its mission and goals
Provide executive sponsorship of projects
Ensure that there is a high degree of coordination between clinical,
business and information technology departments
Provide oversight and/or approve Information Technology projects of a
moderate to large scale
Help resolve project priority conflicts
Review proposals for non-funded requests and assist in obtaining
contingency funding where appropriate
Review annual project budgets (capital and operating) and ensure
projects meet Cambridge Health Alliance's needs
Review IT service metrics and monitor performance improvements
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CHA – IT Prioritization Challenges
 Multiple demands, constrained funds
 Complexity of system interfaces and integration
 Clinical vs. administrative system needs
 No new programs, services without IT
involvement/assessment of resources
 Management of human resources and workload: Intense
local competition for Epic trained resources
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CHA’s EHR – Strategic IT Investment and
the Operational Implications
 Electronic Health Record Deployment
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Ongoing provider and staff training on application-ongoing changes
Workflow changes
Physical plant changes
Job responsibility changes/Labor impact
Provider time and engagement for ongoing application changes
New process supports
Equipment/devices – infection control, ergonomics, general usage,
security
Patient use and expectations
Issues of integration for unique services (Dental, Elder Service Plan,
Occupational Health)
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FY’13 IT Support of System Strategy
 Leverage EHR investment
 Achieve Meaningful Use Requirements – Stage 1 audits and
prepare for Stage 2, Quality Measures and Objectives
 HIE
 Invest in Robust Data Analytics & Reporting (business
intelligence software) to support:
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Achievement of regulatory, payer and quality reporting requirements,
including Clinical Decision Support
 Mobile and Cloud Computing
 ICD-10 Conversion
 Patient self management
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CHA – Strategic IT Investment and Operational
Implications ACO & PCMH Development
 Shift to managing a population means need for whole new
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data set – enrolled members/patients total claims experience
Development of a HIPAA compliant data repository shared
between payer and ACO (delivery system, MD group or other)
Analytics to model cost and utilization at the population,
patient and system level over time; and to assess new contract
proposals, tiered network development to manage cost
New reporting requirements and development of regular
scorecards for use by executive team and at practice level to
share cost and quality and outcomes trends
NCQA PCMH Accreditation – reporting required for panel
definitions, population health outcomes including chronic care
management results
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ACO Development:
Population Health Interventions
 Creation of data repository using EMR/claims data
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Collaboration with Community Based Partners
 Mapping of all patients by address with smoking behavior
identified on EMR problem list
 Identification of “hot spot” areas in communities served by CHA
 Collaboration and linkage with City Housing Authority to impact
behavior and practice, provide group interventions at Housing
Authority sites, build referral lists, etc.
Identification of Employee Wellness Needs
 Use of claims data/diagnoses to identify service utilization to
understand population health needs of employee population
 Development of associated smoking cessation, exercise
programs, self management programs to reduce days lost at
work, reduce premium costs for employer
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Multilingual Services/Patient Services
Dispatching
 Operational Problem:
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$6m annual budget; 150 interpreters; 3 campuses & 12 health centers; 24x7 access
needs
Regulatory requirement to assure linguistically appropriate care
Unsustainable cost growth; need for improved telephone access
 Solution:
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Development and deployment of web based interpreter request and dispatching system
Integrated voice recognition application to allow interpreters to complete service call
Deployment of dual handle phones for 3 way conversation with remote interpreters
Automatic rollover to contracted language services as needed if on site capacity in full
use
Deployment of video interpreting system-wide supports efficient use of remote pool of
interpreters
 Results:
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Tracking of interpreter productivity; type and duration of services
Ability to service more calls with fewer staff
Application has been expanded to support system-wide transport requests
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Patient Engagement:
 Many system-wide efforts leveraging the EHR in improving
quality and patient care while also meeting Meaningful use
requirements
 Implementation of multiple solutions via a patient portal:
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Patients documentation of their own glucose, blood pressure, peak
flow and weight readings in flow sheets that are integrated in the
electronic medical record
Automatic release of specific lab results
Preventive care and PHQ9 questionnaires
Prescriptions renewal, request medical advice and appointments
Patients can download relevant pieces of their medical record to
USB or personal computer
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CHA – IT Solutions to Operational
Demands: CHA Intranet
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CHA – IT Solutions to Operational
Demands: Data Portal
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CHA – IT Solutions to Operational
Demands: Meaningful Use Tracking Tool
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CHA – IT Solutions to Operational Demands:
Meaningful Use Tracking Tool
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IT Solutions to Operational Demands
means Reliance on IT
 Multiple drivers for IT-Operations planning:
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Data/analytics
 Marketing/business development
 Financial planning/assessment
Applications for specific service line/departmental core support
Safety and Quality infrastructure
Communications
Regulatory compliance
Integration/networking with external parties
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Discussion/Questions
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Common Sense Strategies for Uncommon Times
Presented by Tim Tindle, Executive Vice President & Chief Information Officer
Agenda
Overview Harris Health System
Integrating the Healthcare Delivery System
Today and Tomorrow's Challenges
Open Discussion
harrishealth.org
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Caring for Harris County, Texas
Population: 4,180,894 (2011)
Most populous in Texas
3rd most populous in U.S.
1.25 million uninsured
 Current: 311,000 unduplicated
lives
 Projected: 375,000 unduplicated
lives
harrishealth.org
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Who We Are
Created by Harris County voters in November,
1965
 Safety Net Provider
 Serving Uninsured & underserved
Our workforce
 8,500 employees
 4000 Physicians & Students
 $1.2 billion annual budget
Volumes (FY2013)
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harrishealth.org
Outpatient visits - 1,742,429
Hospital admissions - 48,544
Births (babies delivered) - 6,643
Emergency visits - 173,651
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Our Hospitals
Harris Health – Ben Taub Hospital
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586 licensed beds
Level I Trauma Center
Only regional psychiatric emergency center
Teaching hospital for Baylor College of Medicine
Harris Health – LBJ Hospital
 328 licensed beds
 First and busiest Level III Trauma Center in Texas
 Teaching hospital for UTHealth
Harris Health – Quentin Mease Hospital
 CARF Accredited Physical Medicine and
Rehabilitation
 Geriatric skilled nursing
harrishealth.org
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Ambulatory Care: Wellness & Prevention
16 community health centers
 Primary Care
7 school-based clinics
Dental center
Dialysis center (22 stations)
15 homeless shelter clinics
5 mobile health units
 Immunization and medical
outreach programs
HIV/AIDS treatment center
3 specialty and diagnostic
locations
harrishealth.org
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INTEGRATING THE HEALTHCARE
DELIVERY SYSTEM
harrishealth.org
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EHR Vision
Single electronic health record across continuum
of care.
 Single source of truth
 Primary, Specialty, Acute, Sub-Acute
 Available across our system
Facilitate & coordinate access to care
Provide analytics for managing the health of our
community and for process improvement
harrishealth.org
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Medical Records Before…
harrishealth.org
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Harris Health EHR Implementation
Our Journey
Multi-phased, highly integrated approach
Phase 1
Go-Live:
2006 / 2007
Base EHR - Clinical
Repository
Ambulatory EHR
IP Clerk Order Entry
harrishealth.org
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Epic Ambulatory EHR
Physician Order Entry & Documentation
 (100% Adoption)
Electronic Prescribing (e-Rx)
Nurse Documentation
Clinical Decision Support
Health Maintenance
My Health Patient Portal
Electronic Signatures
Information / Analytics
harrishealth.org
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Harris Health EHR Implementation
Our Journey
Multi-phased, highly integrated approach
Phase 2
Phase 1
Go-Live:
2009
Go-Live:
2006 / 2007
Base EHR - Clinical
Repository
IP Pharmacy
Ambulatory EHR
Epic Business
(ADT, ASAP, & HB)
IP Clerk Order Entry
eMAR
harrishealth.org
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Epic Business System
Patient Access
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Registration
ADT (Admission, Discharge, Transfer)
Enterprise wide appointment scheduling
Emergency department system
Patient Accounting
 Billing
 Collections & Follow-up
 Payments
Health Information Management
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harrishealth.org
Coding/Abstracting – outpatient accounts
Chart Deficiencies
Chart Tracking – charts for patients
Release Of Information
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Harris Health EHR Implementation
Our Journey
Multi-phased, highly integrated approach
Phase 3
Phase 2
Phase 1
Go-Live:
2009
Go-Live:
2010
Go-Live:
2006 / 2007
IP Pharmacy
Specialty Clinics
Ambulatory EHR
Epic Business
(ADT, ASAP, & HB)
IP & EC Orders
and ClinDoc
IP Clerk Order Entry
eMAR
Base EHR - Clinical
Repository
harrishealth.org
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Epic Inpatient & EC EHR Projects
Epic Inpatient Pharmacy
Physician Order Entry & Documentation
Nurse Order Entry & Documentation
Allied Health Documentation
eMAR (Electronic Medication Administration
Record)
Electronic Signatures
Wireless Infrastructure
Mobile Computing Devices
harrishealth.org
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COORDINATION OF CARE
HARRIS COUNTY SAFETY NET
harrishealth.org
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Coordination of Care Within Harris Health
Referral Management
 306,163 Specialty Clinic Visits last year
 21,369 Surgical Cases
• 10,123 Outpatient Surgery Cases
• 11,246 Inpatient Surgery Cases
 Referral Guidelines
 Case Management Support
 Enterprise Scheduling
harrishealth.org
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Coordination of Care With Affiliates
Referral Management
 External requests and clinical records
 Interface to case management
Affiliate Read Access to EHR
 10 Federally Qualified Health Centers (FQHCs)
 County Jail
Extending Our EHR
 Select affiliated local safety net organizations
• Houston Healthcare for the Homeless
• FQHC – Denver Harbor
harrishealth.org
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Health Information Exchange
Epic EHR to Epic EHR
 Comprehensive Medical Record Exchange
 Worldwide
Non-Epic EHRs
 Continuity of Care Document Exchange
 Standard adopted by vast majority of EHR vendors
Coming Soon
 Integration with local HIE (Greater Houston Health Connect)
Physician Adoption
 Integrated into existing EHR
 Minimal workflow adjustments for care teams
harrishealth.org
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Current EHR Status
Live In All Hospitals & Outpatient Facilities
Virtually 100% Adoption
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> 3400 Physicians
> 1200 Medical Students
> 2300 Nurses
> 2000 Allied health professionals
More than 5,000,000 Patient Visits Using CPOE
& Clinical Documentation
harrishealth.org
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Accomplishments
Access
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Enterprise Scheduling
Centralized patient appointment center
Improved access
Better information on community need
Medical Home Initiative
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Quality
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Jan 2011: Clinics designated NCQA Medical
Home
Track/trend patient progress over a period of
time
Prevent duplication/unnecessary tests
Standardize Care
Disease management
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Population Health Analytics
•
harrishealth.org
Reduced admissions & EC visits
The ability to measure and manage
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Epic Business Impact On HCHD's Case Mix Adjusted Length Of Stay
5.50
5.15
5.11
5.00
5.02
4.96
4.70
4.82
4.75
4.78
4.76
4.69
4.60
4.51
4.50
LOS Days
Ben Taub
Epic
Business
Go-Live
4.91
4.68
4.58
5.13
4.56
LBJ
Epic
Business
Go-Live
4.32
4.26
4.16 4.18
4.00
3.92
3.85
3.50
Average LOS, Overall CMI Adjusted
M
ar
-0
Ap 8
r-0
M 8
ay
-0
Ju 8
n0
Ju 8
l- 0
Au 8
gS e 08
p0
O 8
ct
-0
N 8
ov
D 08
ec
-0
Ja 8
n0
Fe 9
b0
M 9
ar
-0
Ap 9
r-0
M 9
ay
-0
Ju 9
n0
Ju 9
l- 0
Au 9
gS e 09
p0
O 9
ct
-0
N 9
ov
D 09
ec
-0
Ja 9
n10
3.00
harrishealth.org
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Epic: Projected Economic Benefit
Clinical and Business Program Cost Estimate
 $72 Million
Estimated Economic Benefit (5 Yr. Est.)
 Increase Net Patient Revenue : $310 Million
(+36%)
 Meaningful use: $19.0
 Grant: $600k (ARRA Homeless EMR)
Current 5 Year Estimated ROI
 $329.6 Million (FY-10 thru FY-15)
harrishealth.org
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PATIENT IDENTIFICATION
harrishealth.org
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Patient Name Statistics
Total Person within Master Patient Index: 3,428,925
Same Last, First Name shared by 2 or more people: 249,213
Same Last, First Name shared by 5 or more people: 76,354
Same Last, First, Birth Date shared by 2 or more: 69,807
Same Last, First share by 500 or more people: 43,018
Patients named Maria Garcia: 2,488
 # Sharing the same birth date: 231
harrishealth.org
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Biometrics Driver
Patient Safety
Fraud & Abuse
Reduce The Risk of Identity Theft
Reduce Duplicate Medical Records
Improve Patient Experience
 Accelerate Registrations / Check-in
 Decreases Patient Wait Time
harrishealth.org
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Biometric Scanner - Overview
Vendor: HT Systems
Uses infrared light wave to scan patient’s palm.
False acceptance rate is one in 1.25 million
Integrated into our systems and workflow
 Registration / Check-in / Procedure areas
harrishealth.org
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Biometric Patient ID Statistics
New Patients Enrolled
Total Unique Patients Enrolled
2012 Unique Patients Enrolled
2013 YTD Unique Patients Enrolled
2013 YTD Avg Enrolls/day
268,417
137,789
25,719
330
Patients Scanned and Matched
Total Patient Matches
2012 Patient Matches
2013 YTD Patient Matches
2013 YTD Avg Patient Matches/day
1,334,378
929,974
229,003
2,935
harrishealth.org
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Biometric Patient Identification:
Critical Success Factors
Integration Into Systems / Workflow
Commitment To Patient Safety
 No Palm Scan, No Service
Facility Preparation
 Personnel Training & Support
 Patient Communication Materials
harrishealth.org
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National Recognition
H&HN’s 100 Most Wired Health Systems in USA
 Hospital (2011 & 2012)
HIMSS Analytics Stage 6 EHR Adoption
 Inpatient
 Ambulatory ( 2nd in the nation)
harrishealth.org
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Today and Tomorrow's Challenges
Population Health
 Disease Management
 Predictive / Preventive Interventions
 Home Health Remote Monitoring
Accountable Care
 Coordinating / Outsourced Clinical Services
 Payer Model Implementation
Healthcare Reform
 1115 Waiver DSRIP Projects
 ICD-10
 Meaningful Use Stage 2…
harrishealth.org
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Today and Tomorrow's Challenges
Analytics
 Process Improvement
 KPIs for Business & Clinical Operations
 Specific analysis tools
• Cost
• Revenue
 Disease Management
 Predictive Modeling
 Benchmarking
harrishealth.org
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DISCUSSION
harrishealth.org
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